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Lu C, Rosentreter R, Delisle M, White M, Parker CE, Premji Z, Wilson SR, Baker ME, Bhatnagar G, Begun J, Bruining DH, Bryant R, Christensen B, Feagan BG, Fletcher JG, Jairath V, Knudsen J, Kucharzik T, Maaser C, Maconi G, Novak K, Rimola J, Taylor SA, Wilkens R, Rieder F. Systematic review: Defining, diagnosing and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound. Aliment Pharmacol Ther 2024; 59:928-940. [PMID: 38436124 DOI: 10.1111/apt.17918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/29/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Stricturing Crohn's disease (CD) occurs most commonly in the terminal ileum and poses a clinical problem. Cross-sectional imaging modalities such as intestinal ultrasound (IUS), computed tomography enterography (CTE), and magnetic resonance enterography (MRE) allow for assessment of the entire bowel wall and associated peri-enteric findings. Radiologic definitions of strictures have been developed for CTE and MRE; their reliability and responsiveness are being evaluated in index development programs. A comprehensive assessment strategy for strictures using IUS is needed. AIMS To provide a detailed summary of definitions, diagnosis and monitoring of strictures on IUS as well as technical aspects of image acquisition. METHODS We searched four databases up to 6 January 2024. Two-stage screening was done in duplicate. We assessed risk of bias using QUADAS-2. RESULTS There were 56 studies eligible for inclusion. Definitions for strictures on IUS are heterogeneous, but the overall accuracy for diagnosis of strictures is high. The capability of IUS for characterising inflammation versus fibrosis in strictures is not accurate enough to be used in clinical practice or trials. We summarise definitions for improvement of strictures on IUS, and discuss parameters for image acquisition and standardisation. CONCLUSIONS This systematic review is the first step for a structured program to develop a stricture IUS index for CD.
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Affiliation(s)
- Cathy Lu
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Ryan Rosentreter
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Maxime Delisle
- Department of Medicine, Division of Gastroenterology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mattie White
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | - Stephanie R Wilson
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Mark E Baker
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gauraang Bhatnagar
- Centre for Medical Imaging, University College London, London, UK
- Frimley Health NHS Foundation Trust, Surrey, UK
| | - Jakob Begun
- Department of Gastroenterology, Mater Hospital, Brisbane, Queensland, Australia
| | - David H Bruining
- Department of Gastroenterology, Queen Elizabeth Hospital, Adelaide, South Australia
| | - Robert Bryant
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Britt Christensen
- Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Brian G Feagan
- Alimentiv Inc., London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vipul Jairath
- Alimentiv Inc., London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Department of Medicine, Western University, London, Ontario, Canada
| | - John Knudsen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Torsten Kucharzik
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lüneburg, Lüneburg, Germany
| | - Christian Maaser
- Outpatients' Department of Gastroenterology, University Teaching Hospital Lüneburg, Lüneberg, Germany
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Kerri Novak
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Jordi Rimola
- IBD Unit, Radiology Department, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Rune Wilkens
- Digestive Disease Center, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
- Copenhagen Intestinal Ultrasound, Bispebjerg Hospital, Copenhagen, Denmark
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Center for Global Translational Inflammatory Bowel Diseases, Cleveland, Ohio, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Hunter SA, Baker ME, Ream JM, Sweet DE, Austin NA, Remer EM, Primak A, Bullen J, Obuchowski N, Karim W, Herts BR. Visceral adipose tissue volume effect in Crohn's disease using reduced exposure CT enterography. J Appl Clin Med Phys 2024; 25:e14235. [PMID: 38059633 PMCID: PMC10795447 DOI: 10.1002/acm2.14235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/08/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE The purpose of this investigation was to assess the effect of visceral adipose tissue volume (VA) on reader efficacy in diagnosing and characterizing small bowel Crohn's disease using lower exposure CT enterography (CTE). Secondarily, we investigated the effect of lower exposure and VA on reader diagnostic confidence. METHODS Prospective paired investigation of 256 CTE, 129 with Crohn's disease, were reconstructed at 100% and simulated 50% and 30% exposure. The senior author provided the disease classification for the 129 patients with Crohn's disease. Patient VA was measured, and exams were evaluated by six readers for presence or absence of Crohn's disease and phenotype using a 0-10-point scale. Logistic regression models assessed the effect of VA on sensitivity and specificity. RESULTS The effect of VA on sensitivity was significantly reduced at 30% exposure (odds radio [OR]: 1.00) compared to 100% exposure (OR: 1.12) (p = 0.048). There was no statistically significant difference among the exposures with respect to the effect of visceral fat on specificity (p = 0.159). The study readers' probability of agreement with the senior author on disease classification was 60%, 56%, and 53% at 100%, 50%, and 30% exposure, respectively (p = 0.004). When detecting low severity Crohn's disease, readers' mean sensitivity was 83%, 75%, and 74% at 100%, 50%, and 30% exposure, respectively (p = 0.002). In low severity disease, sensitivity also tended to increase as visceral fat increased (ORs per 1000 cm3 increase in visceral fat: 1.32, 1.31, and 1.18, p = 0.010, 0.016, and 0.100, at 100%, 50%, and 30% exposure). CONCLUSIONS While the interaction is complex, VA plays a role in detecting and characterizing small bowel Crohn's disease when exposure is altered, particularly in low severity disease.
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Affiliation(s)
| | - Mark E. Baker
- Imaging Institute – Cleveland ClinicClevelandOhioUSA
| | | | | | | | | | | | - Jennifer Bullen
- Department of Quantitative Health Sciences – Cleveland ClinicClevelandOhioUSA
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences – Cleveland ClinicClevelandOhioUSA
| | - Wadih Karim
- Imaging Institute – Cleveland ClinicClevelandOhioUSA
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Baffoe-Bonnie H, Alnahhal KI, Englund K, Baker ME, Kirksey L. A case series of image-guided percutaneous drainage of abdominal aortic graft infection as bridge therapy. Vascular 2023:17085381231214318. [PMID: 38031998 DOI: 10.1177/17085381231214318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Aortic graft infection (AGI) is a rare complication following endovascular aneurysm repair and is associated with substantial morbidity and mortality. The traditional management of AGI is intravenous antibiotic therapy and surgical explantation. In this case series, percutaneous drainage was used as a bridge therapy in the treatment of AGI. METHODS We report two cases, 78-year-old male and 57-year-old female, in whom image-guided percutaneous drainage was used to treat AGI in two contrasting contexts. Informed consent was obtained from both cases/relatives for publication. RESULTS Both cases underwent successful percutaneous drainage of AGI utilized as a bridge therapy before definitive surgical reconstruction and graft explantation. Each patient had a different outcome. In the first case, the patient's comorbidities and severe disease state could not be overcome, resulting in his death. The second patient benefitted from the percutaneous drainage by allowing her more time ameliorate her malnutrition before definitive surgery. CONCLUSION Data on the outcomes of percutaneous drainage of AGI is limited. The successful procedure described in this case series emphasizes the need to conduct more research to evaluate the safety and efficacy of this treatment approach before the surgical explantation.
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Affiliation(s)
| | - Khaled I Alnahhal
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland, OH, USA
| | - Kristin Englund
- Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA
| | - Mark E Baker
- Abdominal Imaging Section, Imaging Institute and Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lee Kirksey
- Department of Vascular Surgery, Heart Vascular and Thoracic Institute, Cleveland, OH, USA
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Baker ME, Fletcher JG, Church J, Hull T, Dane B, Huang C, Flicek K, Ream J. Future directions in imaging pouches. Abdom Radiol (NY) 2023; 48:3000-3004. [PMID: 37340153 DOI: 10.1007/s00261-023-03971-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/22/2023]
Abstract
The sections of this special issue on the ileal pouch demonstrate that in the nearly 45 years since the ileal pouch has been utilized to treat patients with colitis and familial adenomatous polyposis, a substantial number of patients experience both short- and long-term morbidity and that imaging plays an important role in their management. Further, referral centers are encountering an increasing number of patients with pouch and peri-pouch complications and dysfunction. Many of these patients have had their pouches for years, and many have experienced a reduced quality of life as a result of their symptoms.As we look to the future, what are the specific questions that arise from this compilation of experience from institutions that see large numbers of patients with an ileal pouch? In what areas are we deficient? In what areas are we using the wrong methods? What should we be doing differently?
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Affiliation(s)
- Mark E Baker
- Imaging Institute/L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | | | - James Church
- Department of Surgery, Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| | - Tracy Hull
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bari Dane
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Chenchen Huang
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | | | - Justin Ream
- Imaging Institute/L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Ream JM, Luk L, Sheedy S, Fletcher JG, Church JM, Baker ME. Dynamic ileal pouch emptying studies. Abdom Radiol (NY) 2023; 48:2956-2968. [PMID: 36732408 DOI: 10.1007/s00261-023-03811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
Although much radiologic literature has focused on the short-term post-operative complications associated with ileal pouches, as the number of patients with long-term pouches has grown, there is increasing realization of the functional deficits that may occur long after pouch creation. Dynamic pouch imaging using fluoroscopy and MRI can provide assessment of the underlying causes of symptomatic pouch dysfunction and can provide critical insight to the management of this complex patient population. In this paper, we provide an overview of the unique problems encountered in patients with long-term ileal pouches, and provide an overview of the techniques, interpretation, and reporting for fluoroscopic and MR pouch defecography.
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Affiliation(s)
- Justin M Ream
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Lyndon Luk
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Shannon Sheedy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - J G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - James M Church
- Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| | - Mark E Baker
- Imaging Institute, Digestive Diseases and Surgery Institute, and Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Baker ME, Hull T, Holubar S, Lightner A, Qazi T. Clinical issues facing pouch patients: an introduction to a special issue on the ileal pouch. Abdom Radiol (NY) 2023; 48:2913-2917. [PMID: 36334124 DOI: 10.1007/s00261-022-03723-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
For over 40 years, restorative proctocolectomy has been used in patients with ulcerative colitis or familial adenomatous polyposis undergoing proctocolectomy. Radiologists are now encountering an increasing number of patients with an ileal pouch and therefore need to understand the clinical issues and concerns in these patients. This review is the introduction of a special issue on the ileal pouch and was written with both surgeon and gastroenterology input. The intent is to assist the radiologist in understanding the clinical questions posed by both the patients and their physicians. Subsequent sessions will address specific imaging modalities and techniques, how the gastroenterologists and surgeons address issues with these patients, and a final session summarizing the sessions and speculating on future investigations and approaches.
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Affiliation(s)
- Mark E Baker
- Imaging Institute, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA.
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
- Crohn's Disease Focus Panel of the Society of Abdominal Radiology, East Dundee, USA.
| | - Tracy Hull
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stefan Holubar
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy Lightner
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Taha Qazi
- Department of Gastroenterology and Hepatology, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Bachour SP, Baker ME, Click B. Reply. Clin Gastroenterol Hepatol 2022; 20:2925-2926. [PMID: 35149221 DOI: 10.1016/j.cgh.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Salam P Bachour
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Mark E Baker
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Benjamin Click
- Department of Gastroenterology and Hepatology Cleveland Clinic, Cleveland, Ohio
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Sleiman J, Chirra P, Gandhi NS, Baker ME, Lu C, Gordon IO, Viswanath SE, Rieder F. Crohn's disease related strictures in cross-sectional imaging: More than meets the eye? United European Gastroenterol J 2022; 10:1167-1178. [PMID: 36326993 PMCID: PMC9752301 DOI: 10.1002/ueg2.12326] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/17/2022] [Indexed: 11/06/2022] Open
Abstract
Strictures in Crohn's disease (CD) are a hallmark of long-standing intestinal damage, brought about by inflammatory and non-inflammatory pathways. Understanding the complex pathophysiology related to inflammatory infiltrates, extracellular matrix deposition, as well as muscular hyperplasia is crucial to produce high-quality scoring indices for assessing CD strictures. In addition, cross-sectional imaging modalities are the primary tool for diagnosis and follow-up of strictures, especially with the initiation of anti-fibrotic therapy clinical trials. This in turn requires such modalities to both diagnose strictures with high accuracy, as well as be able to delineate the impact of each histomorphologic component on the individual stricture. We discuss the current knowledge on cross-sectional imaging modalities used for stricturing CD, with an emphasis on histomorphologic correlates, novel imaging parameters which may improve segregation between inflammatory, muscular, and fibrotic stricture components, as well as a future outlook on the role of artificial intelligence in this field of gastroenterology.
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Affiliation(s)
- Joseph Sleiman
- Division of Gastroenterology, Hepatology and NutritionUniversity of Pittsburgh School of MedicinePittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Prathyush Chirra
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOhioUSA
| | | | - Mark E. Baker
- Imaging InstituteDigestive Diseases and Surgery Institute and Cancer InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Cathy Lu
- Division of Gastroenterology and HepatologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Ilyssa O. Gordon
- Department of PathologyRobert J Tomsich Pathology and Laboratory Medicine InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Satish E. Viswanath
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOhioUSA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & NutritionDigestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA,Department of Inflammation and ImmunityLerner Research InstituteCleveland Clinic FoundationClevelandOhioUSA
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El Ouali S, Baker ME, Lyu R, Fletcher JG, Bruining DH, Holubar SD, Click B, Qazi T, Cohen BL, Rieder F. Validation of stricture length, duration and obstructive symptoms as predictors for intervention in ileal stricturing Crohn's disease. United European Gastroenterol J 2022; 10:958-972. [PMID: 36479841 PMCID: PMC9731662 DOI: 10.1002/ueg2.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Risk factors for intervention in terminal ileal (TI) stricturing Crohn's disease (CD) are poorly defined. Novel and rigorous definitions for TI strictures recently became available. OBJECTIVE We aimed to describe the rates of symptoms or need for endoscopic balloon dilation (EBD) or surgery as well as risk factors of progression in a well-defined stricturing CD cohort. METHODS Consecutive adult patients with non-penetrating stricturing TI CD, as defined by centrally-read magnetic resonance enterography CONSTRICT criteria, were separated into a derivation and validation cohort. Clinical and imaging characteristics were collected following prespecified scoring conventions. Primary outcome was a composite endpoint of EBD or surgery ("intervention"). Multivariable analysis was performed. RESULTS Eighty-six patients (48.8% female, median age 36 years) met selection criteria, 17.4% had prior EBD, 59.3% previously received biologics and 58.1% of strictures were anastomotic. Median follow-up was 63.4 [95% CI: 57, 68.9] months. In the derivation cohort, at 12 and 48 months, 26% and 45% of patients had intervention, respectively. Multivariable analysis showed obstructive symptoms (Hazard ratio [HR] 1.444; 95% CI 1.126-1.852), stricture duration (HR 0.974; 95% CI, 0.954-0.995) and length (HR 1.039; 95% CI, 1.011-1.069) predicted intervention. The concordance index for split-sample validation was 0.74 and 0.67, respectively. Biologics were not associated with intervention. An online risk calculator was constructed. CONCLUSION In patients with TI stricturing CD, 26% and 45% required intervention at 1 and 4 years. Obstructive symptoms, stricture duration and length were independent and validated predictors of the need for intervention. These findings are important for clinical practice and aid in the design of future trials for CD strictures.
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Affiliation(s)
- Sara El Ouali
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
- Digestive Disease InstituteCleveland ClinicAbu DhabiUAE
| | | | - Ruishen Lyu
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
| | | | - David H. Bruining
- Department of Gastroenterology & HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Stefan D. Holubar
- Department of Colorectal SurgeryDigestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Benjamin Click
- Division of Gastroenterology and HepatologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Taha Qazi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
- Digestive Disease InstituteCleveland ClinicAbu DhabiUAE
| | - Benjamin L. Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
- Digestive Disease InstituteCleveland ClinicAbu DhabiUAE
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
- Digestive Disease InstituteCleveland ClinicAbu DhabiUAE
- Department of Inflammation and ImmunityLerner Research InstituteCleveland Clinic FoundationClevelandOhioUSA
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Bachour SP, Shah RS, Lyu R, Nakamura T, Shen M, Li T, Dane B, Barnes EL, Rieder F, Cohen B, Qazi T, Lashner B, Achkar JP, Philpott J, Holubar SD, Lightner AL, Regueiro M, Axelrad J, Baker ME, Click B. Test Characteristics of Cross-sectional Imaging and Concordance With Endoscopy in Postoperative Crohn's Disease. Clin Gastroenterol Hepatol 2022; 20:2327-2336.e4. [PMID: 34968729 PMCID: PMC9234099 DOI: 10.1016/j.cgh.2021.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Postoperative Crohn's disease (CD) surveillance relies on endoscopic monitoring. The role of cross-sectional imaging is less clear. We evaluated the concordance of cross-sectional enterography with endoscopic recurrence and the predictive ability of radiography for future CD postoperative recurrence. METHODS We performed a multi-institution retrospective cohort study of postoperative adult patients with CD who underwent ileocolonoscopy and cross-sectional enterography within 90 days of each other following ileocecal resection. Imaging studies were interpreted by blinded, expert CD radiologists. Patients were categorized by presence of endoscopic postoperative recurrence (E+) (modified Rutgeerts' score ≥i2b) or radiographic disease activity (R+) and grouped by concordance status. RESULTS A total of 216 patients with CD with paired ileocolonoscopy and imaging were included. A majority (54.2%) exhibited concordance (34.7% E+/R+; 19.4% E-/R-) between studies. The plurality (41.7%; n = 90) were E-/R+ discordant. Imaging was highly sensitive (89.3%), with low specificity (31.8%), in detecting endoscopic postoperative recurrence. Intestinal wall thickening, luminal narrowing, mural hyper-enhancement, and length of disease on imaging were associated with endoscopic recurrence (all P < .01). Radiographic disease severity was associated with increasing Rutgeerts' score (P < .001). E-/R+ patients experienced more rapid subsequent endoscopic recurrence (hazard ratio, 4.16; P = .033) and increased rates of subsequent endoscopic (43.8% vs 22.7%) and surgical recurrence (20% vs 9.5%) than E-/R- patients (median follow-up, 4.5 years). CONCLUSIONS Cross-sectional imaging is highly sensitive, but poorly specific, in detecting endoscopic disease activity and postoperative recurrence. Advanced radiographic disease correlates with endoscopic severity. Patients with radiographic activity in the absence of endoscopic recurrence may be at increased risk for future recurrence, and closer monitoring should be considered.
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Affiliation(s)
- Salam P Bachour
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Ravi S Shah
- Cleveland Clinic Department of Internal Medicine, Cleveland, Ohio
| | - Ruishen Lyu
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio
| | - Takahiro Nakamura
- New York University Department of Internal Medicine, New York, New York
| | - Michael Shen
- New York University Department of Internal Medicine, New York, New York
| | - Terry Li
- New York University Department of Internal Medicine, New York, New York
| | - Bari Dane
- New York University Department of Radiology, New York, New York
| | - Edward L Barnes
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, North Carolina
| | - Florian Rieder
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Benjamin Cohen
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Taha Qazi
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Bret Lashner
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Jean Paul Achkar
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Jessica Philpott
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Stefan D Holubar
- Cleveland Clinic Department of Colorectal Surgery, Cleveland, Ohio
| | - Amy L Lightner
- Cleveland Clinic Department of Colorectal Surgery, Cleveland, Ohio
| | - Miguel Regueiro
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Jordan Axelrad
- New York University Department of Gastroenterology and Hepatology, New York, New York
| | - Mark E Baker
- Cleveland Clinic Imaging Institute, Cleveland, Ohio
| | - Benjamin Click
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio.
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Steiner CA, Berinstein JA, Louissaint J, Higgins PDR, Spence JR, Shannon C, Lu C, Stidham RW, Fletcher JG, Bruining DH, Feagan BG, Jairath V, Baker ME, Bettenworth D, Rieder F. Biomarkers for the Prediction and Diagnosis of Fibrostenosing Crohn's Disease: A Systematic Review. Clin Gastroenterol Hepatol 2022; 20:817-846.e10. [PMID: 34089850 PMCID: PMC8636551 DOI: 10.1016/j.cgh.2021.05.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Intestinal strictures are a common complication of Crohn's disease (CD). Biomarkers of intestinal strictures would assist in their prediction, diagnosis, and monitoring. Herein we provide a comprehensive systematic review of studies assessing biomarkers that may predict or diagnose CD-associated strictures. METHODS We performed a systematic review of PubMed, EMBASE, ISI Web of Science, Cochrane Library, and Scopus to identify citations pertaining to biomarkers of intestinal fibrosis through July 6, 2020, that used a reference standard of full-thickness histopathology or cross-sectional imaging or endoscopy. Studies were categorized based on the type of biomarker they evaluated (serum, genetic, histopathologic, or fecal). RESULTS Thirty-five distinct biomarkers from 3 major groups were identified: serum (20 markers), genetic (9 markers), and histopathology (6 markers). Promising markers include cartilage oligomeric matrix protein, hepatocyte growth factor activator, and lower levels of microRNA-19-3p (area under the curves were 0.805, 0.738, and 0.67, respectively), and multiple anti-flagellin antibodies (A4-Fla2 [odds ratio, 3.41], anti Fla-X [odds ratio, 2.95], and anti-CBir1 [multiple]). Substantial heterogeneity was observed and none of the markers had undergone formal validation. Specific limitations to acceptance of these markers included failure to use a standardized definition of stricturing disease, lack of specificity, and insufficient relevance to the pathogenesis of intestinal strictures or incomplete knowledge regarding their operating properties. CONCLUSIONS There is a lack of well-defined studies on biomarkers of intestinal stricture. Development of reliable and accurate biomarkers of stricture is a research priority. Biomarkers can support the clinical management of CD patients and aid in the stratification and monitoring of patients during clinical trials of future antifibrotic drug candidates.
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Affiliation(s)
- Calen A Steiner
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Jeffrey A Berinstein
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jeremy Louissaint
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Peter D R Higgins
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jason R Spence
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, Michigan
| | - Carol Shannon
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Cathy Lu
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ryan W Stidham
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | | | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Brian G Feagan
- Alimentiv Inc, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Vipul Jairath
- Alimentiv Inc, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Mark E Baker
- Section of Abdominal Imaging, Imaging Institute, Digestive Diseases and Surgery Institute and Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University of Münster, Münster, Germany
| | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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12
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Inoue A, Bartlett DJ, Shahraki N, Sheedy SP, Heiken JP, Voss BA, Fidler JL, Tootooni MS, Sir MY, Pasupathy K, Baker ME, Rieder F, Lightner AL, Deepak P, Bruining DH, Fletcher JG. Predicting Risk of Surgery in Patients With Small Bowel Crohn's Disease Strictures Using Computed Tomography and Magnetic Resonance Enterography. Inflamm Bowel Dis 2022; 28:1677-1686. [PMID: 35032168 PMCID: PMC9924041 DOI: 10.1093/ibd/izab332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to determine if patient symptoms and computed tomography enterography (CTE) and magnetic resonance enterography (MRE) imaging findings can be used to predict near-term risk of surgery in patients with small bowel Crohn's disease (CD). METHODS CD patients with small bowel strictures undergoing serial CTE or MRE were retrospectively identified. Strictures were defined by luminal narrowing, bowel wall thickening, and unequivocal proximal small bowel dilation. Harvey-Bradshaw index (HBI) was recorded. Stricture observations and measurements were performed on baseline CTE or MRE and compared to with prior and subsequent scans. Patients were divided into those who underwent surgery within 2 years and those who did not. LASSO (least absolute shrinkage and selection operator) regression models were trained and validated using 5-fold cross-validation. RESULTS Eighty-five patients (43.7 ± 15.3 years of age at baseline scan, majority male [57.6%]) had 137 small bowel strictures. Surgery was performed in 26 patients within 2 years from baseline CTE or MRE. In univariate analysis of patients with prior exams, development of stricture on the baseline exam was associated with near-term surgery (P = .006). A mathematical model using baseline features predicting surgery within 2 years included an HBI of 5 to 7 (odds ratio [OR], 1.7 × 105; P = .057), an HBI of 8 to 16 (OR, 3.1 × 105; P = .054), anastomotic stricture (OR, 0.002; P = .091), bowel wall thickness (OR, 4.7; P = .064), penetrating behavior (OR, 3.1 × 103; P = .096), and newly developed stricture (OR: 7.2 × 107; P = .062). This model demonstrated sensitivity of 67% and specificity of 73% (area under the curve, 0.62). CONCLUSIONS CTE or MRE imaging findings in combination with HBI can potentially predict which patients will require surgery within 2 years.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Narges Shahraki
- Center for the Science of Health Care, Mayo Clinic, Rochester, MN, USA
| | | | - Jay P Heiken
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin A Voss
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammad S Tootooni
- Department of Health Informatics & Data Science, Loyola University Chicago, Chicago, IL, USA
| | - Mustafa Y Sir
- Applied Science Manager, Amazon Care, Amazon, Seattle, WA, USA
| | | | - Mark E Baker
- Abdominal Imaging Section, Imaging Institute, Digestive Diseases and Surgery Institute, Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic, Ohio, USA
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USAand
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel G Fletcher
- Address correspondence to: Joel G. Fletcher, Department of Radiology, Mayo Clinic, Rochester, 200 First Street SW, Rochester MN 55905, USA ()
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13
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Walsh RM, Perlmutter BC, Adsay V, Reid MD, Baker ME, Stevens T, Hue JJ, Hardacre JM, Shen GQ, Simon R, Aleassa EM, Augustin T, Eckhoff A, Allen PJ, Goh BK. In brief. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2020.100880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Li X, Liang D, Meng J, Zhou J, Chen Z, Huang S, Lu B, Qiu Y, Baker ME, Ye Z, Cao Q, Wang M, Yuan C, Chen Z, Feng S, Zhang Y, Iacucci M, Ghosh S, Rieder F, Sun C, Chen M, Li Z, Mao R, Huang B, Feng ST. Development and Validation of a Novel Computed-Tomography Enterography Radiomic Approach for Characterization of Intestinal Fibrosis in Crohn's Disease. Gastroenterology 2021; 160:2303-2316.e11. [PMID: 33609503 PMCID: PMC8903088 DOI: 10.1053/j.gastro.2021.02.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/07/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS No reliable method for evaluating intestinal fibrosis in Crohn's disease (CD) exists; therefore, we developed a computed-tomography enterography (CTE)-based radiomic model (RM) for characterizing intestinal fibrosis in CD. METHODS This retrospective multicenter study included 167 CD patients with 212 bowel lesions (training, 98 lesions; test, 114 lesions) who underwent preoperative CTE and bowel resection at 1 of the 3 tertiary referral centers from January 2014 through June 2020. Bowel fibrosis was histologically classified as none-mild or moderate-severe. In the training cohort, 1454 radiomic features were extracted from venous-phase CTE and a machine learning-based RM was developed based on the reproducible features using logistic regression. The RM was validated in an independent external test cohort recruited from 3 centers. The diagnostic performance of RM was compared with 2 radiologists' visual interpretation of CTE using receiver operating characteristic (ROC) curve analysis. RESULTS In the training cohort, the area under the ROC curve (AUC) of RM for distinguishing moderate-severe from none-mild intestinal fibrosis was 0.888 (95% confidence interval [CI], 0.818-0.957). In the test cohort, the RM showed robust performance across 3 centers with an AUC of 0.816 (95% CI, 0.706-0.926), 0.724 (95% CI, 0.526-0.923), and 0.750 (95% CI, 0.560-0.940), respectively. Moreover, the RM was more accurate than visual interpretations by either radiologist (radiologist 1, AUC = 0.554; radiologist 2, AUC = 0.598; both, P < .001) in the test cohort. Decision curve analysis showed that the RM provided a better net benefit to predicting intestinal fibrosis than the radiologists. CONCLUSIONS A CTE-based RM allows for accurate characterization of intestinal fibrosis in CD.
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Affiliation(s)
- Xuehua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Dong Liang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, People’s Republic of China
| | - Jixin Meng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Jie Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Zhao Chen
- Department of Medical Imaging Center, Nan Fang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Siyun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Baolan Lu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Mark E. Baker
- Section of Abdominal Imaging, Imaging Institute, Digestive Disease Institute and Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ziyin Ye
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Qinghua Cao
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Mingyu Wang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, People’s Republic of China
| | - Chenglang Yuan
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, People’s Republic of China
| | - Zhihui Chen
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Shengyu Feng
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, People’s Republic of China
| | - Yuxuan Zhang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, People’s Republic of China
| | - Marietta Iacucci
- National Institute for Health Research Biomedical Research Institute, Institute of Translational Medicine, University of Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, United Kingdom
| | - Subrata Ghosh
- National Institute for Health Research Biomedical Research Institute, Institute of Translational Medicine, University of Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, United Kingdom
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Canhui Sun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Ziping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, People's Republic of China.
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
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15
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Sleiman J, Ouali SE, Qazi T, Cohen B, Steele SR, Baker ME, Rieder F. Prevention and Treatment of Stricturing Crohn's Disease - Perspectives and Challenges. Expert Rev Gastroenterol Hepatol 2021; 15:401-411. [PMID: 33225766 PMCID: PMC8026566 DOI: 10.1080/17474124.2021.1854732] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Fibrostenosis is a hallmark of Crohn's disease (CD), remains a challenge in today's clinical management of inflammatory bowel disease patients and represents a key event in the disease course necessitating improved preventative strategies and a multidisciplinary approach to diagnosis and management. With the advent of anti-fibrotic therapies and well-defined clinical endpoints for stricturing CD, there is promise to impact the natural history of disease.Areas covered: This review summarizes current evidence in the natural history of stricturing Crohn's disease, discusses management approaches as well as future perspectives on intestinal fibrosis.Expert opinion: Currently, there are no specific therapies to prevent progression to fibrosis or to treat it after it becomes clinically apparent. In addition to the international effort by the Stenosis Therapy and Anti-Fibrotic Research (STAR) consortium to standardize definitions and propose endpoints in the management of stricturing CD, further research to improve our understanding of mechanisms of intestinal fibrosis will help pave the way for the development of future anti-fibrotic therapies.
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Affiliation(s)
- Joseph Sleiman
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sara El Ouali
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA,Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Taha Qazi
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Benjamin Cohen
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Scott R. Steele
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mark E. Baker
- Section Abdominal Imaging, Imaging Institute, Digestive Diseases and Surgery Institute, Cleveland, Ohio, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA,Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA,Corresponding author: Florian Rieder, Address: Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue – NC22, Cleveland, OH, 44195,
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16
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Grajo JR, Huang C, Dillman JR, Gee MS, Jaffe TA, Soto JA, Baker ME. MR Enterography of Complicated Crohn Disease: Stricturing and Penetrating Disease. Top Magn Reson Imaging 2021; 30:23-30. [PMID: 33528209 DOI: 10.1097/rmr.0000000000000266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Stricturing and penetrating disease are complications of Crohn disease (CD) that significantly affect patient outcomes. Careful evaluation for such complications is critical to the interpretation of magnetic resonance enterography. This manuscript outlines the key findings related to stricturing and penetrating CD and discusses current understanding of the pathophysiology and prognosis of complicated CD based on the literature.
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Affiliation(s)
- Joseph R Grajo
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Chenchan Huang
- Department of Radiology, NYU Grossman School of Medicine, New York, NY
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tracy A Jaffe
- Department of Radiology, Duke University School of Medicine, Durham, NC
| | - Jorge A Soto
- Department of Radiology, Boston University School of Medicine, Boston, MA
| | - Mark E Baker
- Department of Radiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
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17
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Li XH, Feng ST, Cao QH, Coffey JC, Baker ME, Huang L, Fang ZN, Qiu Y, Lu BL, Chen ZH, Li Y, Bettenworth D, Iacucci M, Sun CH, Ghosh S, Rieder F, Chen MH, Li ZP, Mao R. Degree of Creeping Fat Assessed by Computed Tomography Enterography is Associated with Intestinal Fibrotic Stricture in Patients with Crohn's Disease: A Potentially Novel Mesenteric Creeping Fat Index. J Crohns Colitis 2021; 15:1161-1173. [PMID: 33411893 PMCID: PMC8427713 DOI: 10.1093/ecco-jcc/jjab005] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Emerging evidence points to a link between creeping fat and the pathogenesis of Crohn's disease [CD]. Non-invasive assessment of the severity of creeping fat on cross-sectional imaging modality has seldom been investigated. This study aimed to develop and characterize a novel mesenteric creeping fat index [MCFI] based on computed tomography [CT] in CD patients. METHODS MCFI was developed based on vascular findings on CT in a retrospective cohort [n = 91] and validated in a prospective cohort [n = 30]. The severity of creeping fat was graded based on the extent to which mesenteric fat extended around the intestinal circumference using the vessels in the fat as a marker. The accuracy of MCFI was assessed by comparing it with the degree of creeping fat observed in surgical specimens. The relationship between MCFI and fibrostenosis was characterized by determining if these correlated. The accuracy of MCFI was compared with other radiographic indices [i.e. visceral to subcutaneous fat area ratio and fibrofatty proliferation score]. RESULTS In the retrospective cohort, MCFI had moderate accuracy in differentiating moderate-severe from mild fibrostenosis (area under the receiver operating characteristic [ROC] curve [AUC] = 0.799; p = 0.000). ROC analysis in the retrospective cohort identified a threshold MCFI of > 3 which accurately differentiated fibrostenosis severity in the prospective cohort [AUC = 0.756; p = 0.018]. An excellent correlation was shown between MCFI and the extent of fat wrapping in specimens in the prospective cohort [r = 0.840, p = 0.000]. Neither visceral to subcutaneous fat area ratio nor fibrofatty proliferation score correlated well with the degree of intestinal fibrosis. CONCLUSIONS MCFI can accurately characterize the extent of mesenteric fat wrapping in surgical specimens. It may become another non-invasive measure of CD fibrostenosis.
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Affiliation(s)
- Xue-Hua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Qing-Hua Cao
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - J Calvin Coffey
- Department of Surgery, University Hospital Group Limerick and School of Medicine, University of Limerick, Limerick, Ireland
| | - Mark E Baker
- Section of Abdominal Imaging, Imaging Institute, Digestive Disease Institute and Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Li Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Zhuang-Nian Fang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Bao-Lan Lu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Zhi-Hui Chen
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Yi Li
- Center for Inflammatory Bowel Diseases, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People’s Republic of China
| | - Dominik Bettenworth
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Marietta Iacucci
- NIHR Biomedical Research Institute, Institute of Translational Medicine, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK
| | - Can-Hui Sun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Subrata Ghosh
- NIHR Biomedical Research Institute, Institute of Translational Medicine, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, UK
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Min-Hu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China,Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA,Corresponding author: Ren Mao, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2nd, Guangzhou 510080, People’s Republic of China; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA. Tel: 86-20-87755766-8471; Fax: 86-20-87615805;
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18
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Herts BR, Schreiner A, Dong F, Primak A, Bullen J, Karim W, Nachand D, Hunter S, Baker ME. Effect of obesity on ability to lower exposure for detection of low-attenuation liver lesions. J Appl Clin Med Phys 2020; 22:138-144. [PMID: 33368998 PMCID: PMC7882113 DOI: 10.1002/acm2.13149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/26/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose The purpose of this study was to assess the effect of obesity and iterative reconstruction on the ability to reduce exposure by studying the accuracy for detection of low‐contrast low‐attenuation (LCLA) liver lesions on computed tomography (CT) using a phantom model. Methods A phantom with four unique LCLA liver lesions (5‐ to 15‐mm spheres, –24 to –6 HU relative to 90‐HU background) was scanned without (“thin” phantom) and with (“obese” phantom) a 5‐cm thick fat‐attenuation ring at 150 mAs (thin phantom) and 450 mAs (obese phantom) standard exposures and at 33% and 67% exposure reductions. Images were reconstructed using standard filtered back projection (FBP) and with iterative reconstruction (Adaptive Model‐Based Iterative Reconstruction strength 3, ADMIRE). A noninferiority analysis of lesion detection was performed. Results Mean area under the curve (AUC) values for lesion detection were significantly higher for the thin phantom than for the obese phantom regardless of exposure level (P < 0.05) for both FBP and ADMIRE. At 33% exposure reduction, AUC was noninferior for both FBP and ADMIRE strength 3 (P < 0.0001). At 67% exposure reduction, AUC remained noninferior for the thin phantom (P < 0.0035), but was no longer noninferior for the obese phantom (P ≥ 0.7353). There were no statistically significant differences in AUC between FBP and ADMIRE at any exposure level for either phantom. Conclusions Accuracy for lesion detection was not only significantly lower in the obese phantom at all relative exposures, but detection accuracy decreased sooner while reducing the exposure in the obese phantom. There was no significant difference in lesion detection between FBP and ADMIRE at equivalent exposure levels for either phantom.
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Affiliation(s)
- Brian R Herts
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Andrew Schreiner
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Frank Dong
- Department of Medical Physics - Desk AC-211, Cleveland Clinic, Imaging Institute, Beachwood, OH, USA
| | - Andrew Primak
- c/o Imaging Institute - Desk AC-221, Siemens Healthineers, Beachwood, OH, USA
| | - Jennifer Bullen
- Department of Quantitative Health Sciences - JJN3, Cleveland Clinic, Cleveland, OH, USA
| | - Wadih Karim
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Douglas Nachand
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Sara Hunter
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
| | - Mark E Baker
- Cleveland Clinic, Imaging Institute - Desk L10, Cleveland, OH, USA
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19
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Gandhi NS, Dillman JR, Grand DJ, Huang C, Fletcher JG, Al-Hawary MM, Anupindi SA, Baker ME, Bruining DH, Chatterji M, Fidler JL, Gee MS, Grajo JR, Guglielmo FF, Jaffe TA, Park SH, Rimola J, Taouli B, Taylor SA, Yeh B. Computed tomography and magnetic resonance enterography protocols and techniques: survey of the Society of Abdominal Radiology Crohn's Disease Disease-Focused Panel. Abdom Radiol (NY) 2020; 45:1011-1017. [PMID: 31982931 DOI: 10.1007/s00261-020-02407-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To survey Society of Abdominal Radiology Crohn's Disease (CD) Disease-Focused Panel (DFP) members to understand state-of-the-art CT/MR enterography (CTE/MRE) protocols and variability between institutions. METHODS This study was determined by an institutional review board to be "exempt" research. The survey consisted of 70 questions about CTE/MRE patient preparation, administration of contrast materials, imaging techniques, and other protocol details. The survey was administered to DFP members using SurveyMonkey® (Surveymonkey.com). Descriptive statistical analyses were performed. RESULTS Responses were received from 16 DFP institutions (3 non-USA, 2 pediatric); 15 (94%) were academic/university-based. 10 (63%) Institutions image most CD patients with MRE; 4 (25%) use CTE and MRE equally. Hypoperistaltic medication is given for MRE at 13 (81%) institutions versus only 2 (13%) institutions for CTE. Most institutions have a technologist or nurse monitor oral contrast material drinking (n = 12 for CTE, 75%; n = 11 for MRE, 69%). 2 (13%) institutions use only dual-energy capable scanners for CTE, while 9 (56%) use either a single-energy or dual-energy scanner based on availability. Axial CTE images are reconstructed at 2-3 mm thickness at 8 (50%) institutions, > 3 mm at 5 (31%), and < 2 mm at 3 (19%) institutions. 13 (81%) institutions perform MRE on either 1.5 or 3T scanners without preference. All institutions perform MRE multiphase postcontrast imaging (median = 4 phases), ranging from 20 to 600 s after contrast material injection. CONCLUSION CTE and MRE protocol knowledge from DFP institutions can help radiology practices optimize/standardize protocols, potentially improving image quality and patient outcomes, permitting objective comparisons between examinations, and facilitating research.
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Affiliation(s)
- Namita S Gandhi
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David J Grand
- Department of Radiology, Rhode Island Hospital, Providence, RI, USA
| | - Chenchan Huang
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | | | - Mahmoud M Al-Hawary
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia & University of Pennsylvania, Philadelphia, PA, USA
| | - Mark E Baker
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Manjil Chatterji
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Grajo
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tracy A Jaffe
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Benjamin Yeh
- Department of Radiology, University of California, San Francisco, USA
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20
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Guglielmo FF, Anupindi SA, Fletcher JG, Al-Hawary MM, Dillman JR, Grand DJ, Bruining DH, Chatterji M, Darge K, Fidler JL, Gandhi NS, Gee MS, Grajo JR, Huang C, Jaffe TA, Park SH, Rimola J, Soto JA, Taouli B, Taylor SA, Baker ME. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms. Radiographics 2020; 40:354-375. [DOI: 10.1148/rg.2020190091] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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21
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Gordon IO, Bettenworth D, Bokemeyer A, Srivastava A, Rosty C, de Hertogh G, Robert ME, Valasek MA, Mao R, Kurada S, Harpaz N, Borralho P, Pai RK, Pai RK, Odze R, Feakins R, Parker CE, Nguyen T, Jairath V, Baker ME, Bruining DH, Fletcher JG, Feagan BG, Rieder F. Histopathology Scoring Systems of Stenosis Associated With Small Bowel Crohn's Disease: A Systematic Review. Gastroenterology 2020; 158:137-150.e1. [PMID: 31476299 PMCID: PMC7649049 DOI: 10.1053/j.gastro.2019.08.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/29/2019] [Accepted: 08/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Stenosis is a common complication of Crohn's disease (CD) that has no effective medical therapy. Development of antifibrotic agents will require testing in randomized controlled trials. Computed tomography enterography- and magnetic resonance enterography-based technologies might be used to measure outcomes in these trials. These approaches have been validated in studies of patients with symptomatic strictures who underwent imaging evaluations followed by resection with histopathologic grading of the intestinal tissue for inflammation and/or fibrosis (the reference standard). Imaging findings have correlated with findings from quantitative or semiquantitative histologic evaluation of the degree of fibromuscular stenosis and/or inflammation on the resection specimen. However, it is not clear whether histologic findings are an accurate reference standard. We performed a systematic review of all published histologic scoring systems used to assess stenosing CD. METHODS We performed a comprehensive search of Embase and MEDLINE of studies through March 13, 2019, that used a histologic scoring system to characterize small bowel CD and assessed inflammatory and fibrotic alterations within the same adult individual. All scores fitting the criteria were included in our analysis, independent of the presence of stricturing disease, as long as inflammation and fibrosis were evaluated separately but in the same scoring system. RESULTS We observed substantial heterogeneity among the scoring systems, which were not derived from modern principles for evaluative index development. None had undergone formal validity or reliability testing. None of the existing indices had been constructed according to accepted methods for the development of evaluative indices. Basic knowledge regarding their operating properties were lacking. Specific indices for evaluating the important pathologic component of myofibroblast hypertrophy or hyperplasia have not been proposed. CONCLUSIONS In a systematic review of publications, we found a lack of validated histopathologic scoring systems for assessment of fibromuscular stenosis. Data that describe the operating properties of existing cross-sectional imaging techniques for stenosing CD should be questioned. Development and validation of a histopathology index is an important research priority.
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Affiliation(s)
- Ilyssa O Gordon
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Arne Bokemeyer
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Amitabh Srivastava
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christophe Rosty
- Department of Clinical Pathology, The University of Melbourne, Parville, Victoria, Australia; Envoi Specialist Pathologists, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gert de Hertogh
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Marie E Robert
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Mark A Valasek
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Ren Mao
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Satya Kurada
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, Ohio
| | - Noam Harpaz
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paula Borralho
- Faculdade de Medicina da Universidade de Lisboa, Instituto de Anatomia Patológica, Lisbon, Portugal
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Robert Odze
- Pathology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roger Feakins
- Department of Cellular Pathology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Tran Nguyen
- Robarts Clinical Trials, Inc, London, Ontario, Canada
| | - Vipul Jairath
- Robarts Clinical Trials, Inc, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Mark E Baker
- Department of Diagnostic Radiology, Imaging Institute, Digestive Diseases and Surgery Institute, Cleveland, Ohio; Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - J G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Brian G Feagan
- Robarts Clinical Trials, Inc, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada
| | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, Ohio.
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22
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Mao R, Kurada S, Gordon IO, Baker ME, Gandhi N, McDonald C, Coffey JC, Rieder F. The Mesenteric Fat and Intestinal Muscle Interface: Creeping Fat Influencing Stricture Formation in Crohn's Disease. Inflamm Bowel Dis 2019; 25:421-426. [PMID: 30346528 DOI: 10.1093/ibd/izy331] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Indexed: 12/12/2022]
Abstract
Adipose tissue is present in close proximity to various organs in the human body. One prominent example is fat contained in the mesentery that is contiguous with all abdominal digestive organs including the intestine. Despite the fact that mesenteric fat-wrapping around the inflamed gut (so called "creeping fat") was described as a characteristic feature of Crohn's disease (CD) in the early 1930s, the functional implications of creeping fat have received only recent attention. As a potent producer of fatty acids, cytokines, growth factors, and adipokines, creeping fat plays an important role in regulation of immunity and inflammation. Increasing evidence points to a link between creeping fat and intestinal inflammation in CD, where histopathologic evaluation shows a significant association between creeping fat and connective tissue changes in the bowel wall, such as muscular hypertrophy, fibrosis, and stricture formation. In addition, emerging mechanistic data indicate a link between creeping fat, muscularis propria hyperplasia, and stricturing disease. Information on fat-mesenchymal interactions in other organs could provide clues to fill the fundamental knowledge gap on the role of distinct components of creeping fat in intestinal fibrosis and stricture formation. Future studies will provide important new information that in turn could lead to novel therapeutic agents aimed at prevention or treatment of CD-associated fibrosis and stricture formation.
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Affiliation(s)
- Ren Mao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, China.,Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute.,Department of Inflammation and Immunity, Lerner Research Institute
| | - Satya Kurada
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute.,Department of Inflammation and Immunity, Lerner Research Institute
| | - Ilyssa O Gordon
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute
| | - Mark E Baker
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute.,Section of Abdominal Imaging, Imaging Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Namita Gandhi
- Section of Abdominal Imaging, Imaging Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - J Calvin Coffey
- Department of Surgery, Graduate Entry Medical School, University Hospital Limerick Group, Centre for Interventions in Infection, Inflammation and Immunity, University of Limerick, Limerick, Ireland
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute.,Department of Inflammation and Immunity, Lerner Research Institute
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Abstract
Necrosis significantly increases rates of morbidity and mortality in acute pancreatitis. Hospitalists and general internists are on the front lines in identifying severe cases and consulting the appropriate specialists for optimal multidisciplinary care.
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Affiliation(s)
- Tiffany Y Chua
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - R Matthew Walsh
- Chairman, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.,Vice-Chairman, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.,Rich Family Distinguished Chair of Digestive Diseases, Cleveland Clinic, Cleveland, OH, USA.,Chairman, Academic Department of Surgery, Education Institute, Cleveland Clinic, Cleveland, OH, USA.,Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Mark E Baker
- Section of Abdominal Imaging, Imaging Institute, Digestive Disease and Cancer Institutes, Cleveland Clinic, Cleveland, OH, USA.,Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.,Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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24
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Baker ME, Fletcher JG, Al-Hawary M, Bruining D. Interdisciplinary Updates in Crohn’s Disease Reporting Nomenclature, and Cross-Sectional Disease Monitoring. Radiol Clin North Am 2018; 56:691-707. [DOI: 10.1016/j.rcl.2018.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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25
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Rieder F, Bettenworth D, Ma C, Parker CE, Williamson LA, Nelson SA, van Assche G, Di Sabatino A, Bouhnik Y, Stidham RW, Dignass A, Rogler G, Taylor SA, Stoker J, Rimola J, Baker ME, Fletcher JG, Panes J, Sandborn WJ, Feagan BG, Jairath V. An expert consensus to standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Crohn's disease. Aliment Pharmacol Ther 2018; 48:347-357. [PMID: 29920726 PMCID: PMC6043370 DOI: 10.1111/apt.14853] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/19/2018] [Accepted: 05/26/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Fibrotic stricture is a common complication of Crohn's disease (CD) affecting approximately half of all patients. No specific anti-fibrotic therapies are available; however, several therapies are currently under evaluation. Drug development for the indication of stricturing CD is hampered by a lack of standardised definitions, diagnostic modalities, clinical trial eligibility criteria, endpoints and treatment targets in stricturing CD. AIM To standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Chron's disease. METHODS An interdisciplinary expert panel consisting of 15 gastroenterologists and radiologists was assembled. Using modified RAND/University of California Los Angeles appropriateness methodology, 109 candidate items derived from systematic review and expert opinion focusing on small intestinal strictures were anonymously rated as inappropriate, uncertain or appropriate. Survey results were discussed as a group before a second and third round of voting. RESULTS Fibrotic strictures are defined by the combination of luminal narrowing, wall thickening and pre-stenotic dilation. Definitions of anastomotic (at site of prior intestinal resection with anastomosis) and naïve small bowel strictures were similar; however, there was uncertainty regarding wall thickness in anastomotic strictures. Magnetic resonance imaging is considered the optimal technique to define fibrotic strictures and assess response to therapy. Symptomatic strictures are defined by abdominal distension, cramping, dietary restrictions, nausea, vomiting, abdominal pain and post-prandial abdominal pain. Need for intervention (endoscopic balloon dilation or surgery) within 24-48 weeks is considered the appropriate endpoint in pharmacological trials. CONCLUSIONS Consensus criteria for diagnosis and response to therapy in stricturing Crohn's disease should inform both clinical practice and trial design.
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Affiliation(s)
- Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Department of Pathobiology, Lerner Research Institute; Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Christopher Ma
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada,Robarts Clinical Trials Inc., University of Western Ontario, London, ON, Canada
| | - Claire E. Parker
- Robarts Clinical Trials Inc., University of Western Ontario, London, ON, Canada
| | - Lee A. Williamson
- Robarts Clinical Trials Inc., University of Western Ontario, London, ON, Canada
| | - Sigrid A. Nelson
- Robarts Clinical Trials Inc., University of Western Ontario, London, ON, Canada
| | - Gert van Assche
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Yoram Bouhnik
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - Ryan W. Stidham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University of Zürich, Zürich, Switzerland
| | - Stuart A. Taylor
- Center for Medical Imaging, University College London, London, UK
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jordi Rimola
- Department of Radiology, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Mark E. Baker
- Imaging Institute/L10, Cleveland Clinic, Cleveland, OH, USA
| | | | - Julian Panes
- Institut d’Investigacions Biomèdiques August Pi i Sunyer-Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
| | - William J. Sandborn
- Robarts Clinical Trials Inc., University of Western Ontario, London, ON, Canada,Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Brian G. Feagan
- Robarts Clinical Trials Inc., University of Western Ontario, London, ON, Canada,Department of Medicine, University of Western Ontario, London, ON, Canada,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | - Vipul Jairath
- Robarts Clinical Trials Inc., University of Western Ontario, London, ON, Canada,Department of Medicine, University of Western Ontario, London, ON, Canada,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
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26
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Kachala SS, Rice TW, Baker ME, Rajeswaran J, Thota PN, Murthy SC, Blackstone EH, Zanoni A, Raja S. Value of routine timed barium esophagram follow-up in achalasia after myotomy. J Thorac Cardiovasc Surg 2018; 156:871-877.e2. [DOI: 10.1016/j.jtcvs.2018.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 02/21/2018] [Accepted: 03/03/2018] [Indexed: 12/29/2022]
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27
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Megibow AJ, Baker ME, Morgan DE, Kamel IR, Sahani DV, Newman E, Brugge WR, Berland LL, Pandharipande PV. Author's Reply. J Am Coll Radiol 2018; 15:591-593. [PMID: 29483047 DOI: 10.1016/j.jacr.2018.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Alec J Megibow
- NYU-Langone Medical Center, Department of Radiology, NYU Radiology Associates, 530 1st Avenue, New York, NY 10016.
| | - Mark E Baker
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elliot Newman
- Department of Surgery, NYU-Langone Medical Center, New York, New York
| | - William R Brugge
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Gastroenterology, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Lincoln L Berland
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pari V Pandharipande
- Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
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28
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Bhattacharya A, Gandhi NS, Baker ME, Chahal P. Gastroenterology and pancreatic adenocarcinoma: what the radiologist needs to know. Abdom Radiol (NY) 2018; 43:364-373. [PMID: 29116342 DOI: 10.1007/s00261-017-1347-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this article, we review the information that radiologists need to know regarding the endoscopic approach to the diagnosis and management of pancreatic cancer. This includes a review of the indications, techniques, and complications of endoscopic ultrasound. We also review information regarding endoscopic retrograde cholangiopancreatography, including the various biliary drainage techniques and the use of endoscopic palliation for patients with pancreatic cancer.
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29
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Megibow AJ, Baker ME, Morgan DE, Kamel IR, Sahani DV, Newman E, Brugge WR, Berland LL, Pandharipande PV. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2017; 14:911-923. [PMID: 28533111 DOI: 10.1016/j.jacr.2017.03.010] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 12/12/2022]
Abstract
The ACR Incidental Findings Committee (IFC) presents recommendations for managing pancreatic cysts that are incidentally detected on CT or MRI. These recommendations represent an update from the pancreatic component of the JACR 2010 white paper on managing incidental findings in the adrenal glands, kidneys, liver, and pancreas. The Pancreas Subcommittee-which included abdominal radiologists, a gastroenterologist, and a pancreatic surgeon-developed this algorithm. The recommendations draw from published evidence and expert opinion, and were finalized by informal iterative consensus. Algorithm branches successively categorize pancreatic cysts based on patient characteristics and imaging features. They terminate with an ascertainment of benignity and/or indolence (sufficient to discontinue follow-up), or a management recommendation. The algorithm addresses most, but not all, pathologies and clinical scenarios. Our goal is to improve quality of care by providing guidance on how to manage incidentally detected pancreatic cysts.
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Affiliation(s)
- Alec J Megibow
- Department of Radiology, NYU-Langone Medical Center, New York, New York.
| | - Mark E Baker
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elliot Newman
- Department of Surgery, NYU-Langone Medical Center, New York, New York
| | - William R Brugge
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lincoln L Berland
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pari V Pandharipande
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
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30
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Gandhi NS, Baker ME, Goenka AH, Bullen JA, Obuchowski NA, Remer EM, Coppa CP, Einstein D, Feldman MK, Kanmaniraja D, Purysko AS, Vahdat N, Primak AN, Karim W, Herts BR. Diagnostic Accuracy of CT Enterography for Active Inflammatory Terminal Ileal Crohn Disease: Comparison of Full-Dose and Half-Dose Images Reconstructed with FBP and Half-Dose Images with SAFIRE. Radiology 2016; 280:436-45. [DOI: 10.1148/radiol.2016151281] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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31
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Goenka AH, Herts BR, Dong F, Obuchowski NA, Primak AN, Karim W, Baker ME. Image Noise, CNR, and Detectability of Low-Contrast, Low-Attenuation Liver Lesions in a Phantom: Effects of Radiation Exposure, Phantom Size, Integrated Circuit Detector, and Iterative Reconstruction. Radiology 2016; 280:475-82. [DOI: 10.1148/radiol.2016151621] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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32
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Kim DH, Carucci LR, Baker ME, Cash BD, Dillman JR, Feig BW, Fowler KJ, Gage KL, Noto RB, Smith MP, Yaghmai V, Yee J, Lalani T. ACR Appropriateness Criteria Crohn Disease. J Am Coll Radiol 2016; 12:1048-57.e4. [PMID: 26435118 DOI: 10.1016/j.jacr.2015.07.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 12/11/2022]
Abstract
Crohn disease is a chronic inflammatory disorder involving the gastrointestinal tract, characterized by episodic flares and times of remission. Underlying structural damage occurs progressively, with recurrent bouts of inflammation. The diagnosis and management of this disease process is dependent on several clinical, laboratory, imaging, endoscopic, and histologic factors. In recent years, with the maturation of CT enterography, and MR enterography, imaging has played an increasingly important role in relation to Crohn Disease. In addition to these specialized examination modalities, ultrasound and routine CT have potential uses. Fluoroscopy, radiography, and nuclear medicine may be less beneficial depending on the clinical scenario. The imaging modality best suited to evaluating this disease may change, depending on the target population, severity of presentation, and specific clinical situation. This document presents seven clinical scenarios (variants) in both the adult and pediatric populations and rates the appropriateness of the available imaging options. They are summarized in a consolidated table, and the underlying rationale and supporting literature are presented in the accompanying narrative. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
- David H Kim
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
| | - Laura R Carucci
- Virginia Commonwealth University Medical Center, Richmond, Virginia
| | | | | | | | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Richard B Noto
- Brown University Rhode Island Hospital, Providence, Rhode Island
| | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Judy Yee
- University of California San Francisco, San Francisco, California
| | - Tasneem Lalani
- Inland Imaging Associates and University of Washington, Seattle, Washington
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Sanaka MR, Hayat U, Thota PN, Jegadeesan R, Ray M, Gabbard SL, Wadhwa N, Lopez R, Baker ME, Murthy S, Raja S. Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function. World J Gastroenterol 2016; 22:4918-4925. [PMID: 27239118 PMCID: PMC4873884 DOI: 10.3748/wjg.v22.i20.4918] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/26/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess and compare the esophageal function after peroral endoscopic myotomy (POEM) vs other conventional treatments in achalasia.
METHODS: Chart review of all achalasia patients who underwent POEM, laparoscopic Heller myotomy (LHM) or pneumatic dilation (PD) at our institution between January 2012 and March 2015 was performed. Patient demographics, type of achalasia, prior treatments, pre- and post-treatment timed barium swallow (TBE) and high-resolution esophageal manometry (HREM) findings were compared between the three treatment groups. Patients who had both pre- and 2 mo post-treatment TBE or HREM were included in the final analysis. TBE parameters compared were barium column height, width and volume of barium remaining at 1 and 5 min. HREM parameters compared were basal lower esophageal sphincter (LES) pressures and LES-integrated relaxation pressures (IRP). Data are presented as mean ± SD, median [25th, 75th percentiles] or frequency (percent). Analysis of variance, Kruskal-Wallis test, Pearsons χ2 test and Fishers Exact tests were used for analysis.
RESULTS: A total of 200 achalasia patients were included of which 36 underwent POEM, 22 underwent PD and 142 underwent LHM. POEM patients were older (55.4 ± 16.8 years vs 46.5 ± 15.7 years, P = 0.013) and had higher BMI than LHM (29.1 ± 5.9 kg/m2vs 26 ± 5.1 kg/m2, P = 0.012). More number of patients in POEM and PD groups had undergone prior treatments compared to LHM group (72.2% vs 68.2% vs 44.3% respectively, P = 0.003). At 2 mo post-treatment, all TBE parameters including barium column height, width and volume remaining at 1 and 5 min improved significantly in all three treatment groups (P = 0.01 to P < 0.001) except the column height at 1 min in PD group (P = 0.11) . At 2 mo post-treatment, there was significant improvement in basal LES pressure and LES-IRP in both LHM (40.5 mmHg vs 14.5 mmHg and 24 mmHg vs 7.1 mmHg respectively, P < 0.001) and POEM groups (38.7 mmHg vs 11.4 mmHg and 23.6 mmHg vs 6.6 mmHg respectively, P < 0.001). However, when the efficacy of three treatments were compared to each other in terms of improvement in TBE or HREM parameters at 2 mo, there was no significant difference (P > 0.05).
CONCLUSION: POEM, PD and LHM were all effective in improving esophageal function in achalasia at short-term. There was no difference in efficacy between the three treatments.
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Jacinthe PA, Vidon P, Fisher K, Liu X, Baker ME. Soil Methane and Carbon Dioxide Fluxes from Cropland and Riparian Buffers in Different Hydrogeomorphic Settings. J Environ Qual 2015; 44:1080-1090. [PMID: 26437089 DOI: 10.2134/jeq2015.01.0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Riparian buffers contribute to the mitigation of nutrient pollution in agricultural landscapes, but there is concern regarding their potential to be hot spots of greenhouse gas production. This study compared soil CO and CH fluxes in adjacent crop fields and riparian buffers (a flood-prone forest and a flood-protected grassland along an incised channel) and examined the impact of water table depth (WTD) and flood events on the variability of gas fluxes in riparian zones. Results showed significantly ( < 0.001) higher CO emission in riparian areas than in adjoining croplands (6.8 ± 0.6 vs. 3.6 ± 0.5 Mg CO-C ha yr; mean ± SE). Daily flux of CO and soil temperature were significantly related ( < 0.002), with Q values ranging between 1.75 and 2.53. Significant relationships ( < 0.05) were found between CH daily flux and WTD. Flood events resulted in enhanced CH emission (up to +44.5 mg CH-C m d in a swale) under warm soil conditions (>22°C), but the effect of flooding was less pronounced in early spring (emission <1.06 mg CH-C m d), probably due to low soil temperature. Although CH flux direction alternated at all sites, overall the croplands and the flood-affected riparian forest were CH sources, with annual emission averaging +0.04 ± 0.17 and +0.92 ± 1.6 kg CH-C ha, respectively. In the riparian forest, a topographic depression (<8% of the total area) accounted for 78% of the annual CH emission, underscoring the significance of landscape heterogeneity on CH dynamics in riparian buffers. The nonflooded riparian grassland, however, was a net CH sink (-1.08 ± 0.22 kg CH-C ha yr), probably due to the presence of subsurface tile drains and a dredged/incised channel at that study site. Although these hydrological alterations may have contributed to improvement in the CH sink strength of the riparian grassland, this must be weighed against the water quality maintenance functions and other ecological services provided by riparian buffers.
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Mino JS, Gandhi NS, Stocchi LL, Baker ME, Liu X, Remzi FH, Monteiro R, Vogel JD. Preoperative risk factors and radiographic findings predictive of laparoscopic conversion to open procedures in Crohn's disease. J Gastrointest Surg 2015; 19:1007-14. [PMID: 25820486 DOI: 10.1007/s11605-015-2802-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/10/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Laparoscopy is accepted as a standard surgical approach for Crohn's disease. However, the rate of conversion is high, ranging from 15 to 70 % depending on the population. There are also concerns that conversion results in worsened outcomes versus an initial open procedure. METHODS This study evaluated preoperative radiographic findings to determine who is at increased risk of conversion and may therefore benefit from an initial open approach. A case-matched study included patients from 2004 to 2013 with preoperative CTE/MRE who underwent laparoscopic surgery converted to an open approach, and compared them to laparoscopically completed controls with similar age, same surgeon, and number of previous abdominal operations. Studies were reviewed by two blinded radiologists. Variables included abdominal AP diameter, amount of subcutaneous fat, peritoneal versus pelvic location of disease (greater or lesser hemipelvis or abdomen), intestinal location of disease (colon, TI, ileum, jejunum), and presence, length, and location of strictures, simple or complex fistula, phlegmon, or abscess. Conditional logistic regression evaluated relationships between radiographic variables and conversion. Twenty-seven patients meeting study criteria were compared with 81 controls. RESULTS A negative association between conversion and disease in the left lesser pelvis was found (p = 0.019) and neared significance for left abdomen (p = 0.08). Positive correlations were found with pelvic fistulas (p = 0.003), complex fistulas (p = 0.017), and pelvic abscesses (p = 0.009) and neared significance for Society of Abdominal Radiology classification (p = 0.058). CONCLUSION Preoperative imaging in patients with Crohn's disease can help in selecting the most suitable cases to approach laparoscopically and reduce conversion rates and should be evaluated in conjunction with other preoperative factors.
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Affiliation(s)
- Jeffrey S Mino
- Department of General Surgery, Cleveland Clinic Foundation, A100 Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA,
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Elagili F, Stocchi L, Ozuner G, Mody R, Baker ME, Kiran RP. Predictors of postoperative outcomes for patients with diverticular abscess initially treated with percutaneous drainage. Am J Surg 2015; 209:703-8. [DOI: 10.1016/j.amjsurg.2014.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 05/08/2014] [Accepted: 05/15/2014] [Indexed: 11/28/2022]
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Baker ME. Role of the Barium Esophagram in Antireflux Surgery. Gastroenterol Hepatol (N Y) 2014; 10:677-679. [PMID: 27540340 PMCID: PMC4988226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Mark E Baker
- Professor of Radiology Cleveland Clinic Lerner College of Medicine of CWRU Staff Radiologist Imaging Institute Digestive Disease Institute & Cancer Institute Cleveland Clinic Cleveland, Ohio
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Schoenhagen P, Baker ME. Our preoccupation with ultra-low dose radiation exposure. Low contrast resolution and cardiovascular CT imaging. J Cardiovasc Comput Tomogr 2014; 8:426-8. [PMID: 25439790 DOI: 10.1016/j.jcct.2014.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Paul Schoenhagen
- Section of Cardiovascular Imaging, Imaging Institute, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Mark E Baker
- Section of Abdominal Imaging, Imaging Institute, Digestive Disease Institute & Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Remer EM, Herts BR, Primak A, Obuchowski NA, Greiwe A, Roesel DM, Purysko AS, Feldman MK, De S, Shah SN, Dong F, Monga M, Baker ME. Detection of Urolithiasis: Comparison of 100% Tube Exposure Images Reconstructed with Filtered Back Projection and 50% Tube Exposure Images Reconstructed with Sinogram-affirmed Iterative Reconstruction. Radiology 2014; 272:749-56. [DOI: 10.1148/radiol.14132381] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Relationships of timed barium esophagram (TBE) findings to achalasia types defined by high-resolution manometry (HRM) have not been elucidated. Therefore, we correlated preoperative TBE and HRM measurements in achalasia types and related these to patient symptoms and prior treatments. From 2006 to 2013, 248 achalasia patients underwent TBE and HRM before Heller myotomy. TBE height and width were recorded at 1 and 5 minutes; HRM measured lower esophageal sphincter mean basal pressure, integrated relaxation pressure (IRP), and mean esophageal body contraction amplitude. Achalasia was classified into types I (25%), II (65%), and III (9.7%). TBE height at 5 minutes was higher for I (median 8 cm; interquartile range 6-12) and II (8 cm; 8-11) than for III (1 cm; 0-7). TBE width at 5 minutes was widest (3 cm; 2-4), narrower in II (2 cm; 2-3), and narrowest in I (1 cm; 0-2), P < 0.001. Volume remaining at 1 and 5 minutes was lower in III (1 m(2) ; 0-16) than I (42 m(2) ; 17-106) and II (39 m(2) ; 15-60), highlighting poorer emptying of I and II. Increasing TBE width correlated with deteriorating morphology and function from III to II to I. Symptoms poorly correlated with TBE and HRM. Prior treatment was associated with less regurgitation, faster emptying, and lower IRP. Although TBE and HRM are correlated in many respects, the wide range of their measurements observed in this study reveals a spectrum of morphology and dysfunction in achalasia that is best characterized by the combination of these studies.
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Affiliation(s)
- A Zanoni
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, Ohio, USA
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Goenka AH, Herts BR, Obuchowski NA, Primak AN, Dong F, Karim W, Baker ME. Effect of reduced radiation exposure and iterative reconstruction on detection of low-contrast low-attenuation lesions in an anthropomorphic liver phantom: an 18-reader study. Radiology 2014; 272:154-63. [PMID: 24620913 DOI: 10.1148/radiol.14131928] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To measure the effect of reduced radiation exposure on low-contrast low-attenuation liver lesion detection in an anthropomorphic abdominal phantom by using filtered back projection (FBP) and sinogram-affirmed iterative reconstruction. MATERIALS AND METHODS Eighteen radiologists blinded to phantom and study design interpreted randomized image data sets that contained 36 spherical simulated liver lesions of three sizes and three attenuation differences (5-mm diameter: 12, 18, and 24 HU less than the 90-HU background attenuation of the simulated liver insert; 10- and 15-mm diameter: 6, 12, and 18 HU less than the 90-HU background attenuation) scanned with four discrete exposure settings and reconstructed by using FBP and sinogram-affirmed iterative reconstruction. Response assessment included region-level lesion presence or absence on a five-point diagnostic confidence scale. Statistical evaluation included multireader multicase receiver operating characteristic curve analysis, with nonparametric methods and noninferiority analysis at a margin of -0.10. RESULTS Pooled accuracy at 75% exposure for both FBP and sinogram-affirmed iterative reconstruction was noninferior to 100% exposure (P = .002 and P < .001, respectively). Subsequent exposure reductions resulted in a significant decrease in accuracy. When the smallest (5-mm-diameter) lesions were excluded from analysis, sinogram-affirmed iterative reconstruction was superior to FBP at 100% exposure (P = .011), and sinogram-affirmed iterative reconstruction at 25% and 50% exposure reduction was noninferior to FBP at 100% exposure (P ≤ .013). Reader confidence was greater with sinogram-affirmed iterative reconstruction than with FBP for 10- and 15-mm lesions (2.94 vs 2.76 and 3.62 vs 3.52, respectively). CONCLUSION In this low-contrast low-attenuation liver lesion model, a 25% exposure reduction maintained noninferior diagnostic accuracy. However, detection was inferior with each subsequent exposure reduction, regardless of reconstruction method. Sinogram-affirmed iterative reconstruction and FBP performed equally well at modest exposure reduction (25%-50%). Readers had higher confidence levels with sinogram-affirmed iterative reconstruction for the 10- and 15-mm lesions.
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Affiliation(s)
- Ajit H Goenka
- From the Sections of Abdominal Imaging (A.H.G., B.R.H., W.K., M.E.B.) and Medical Physics (F.D.), Imaging Institute, and Department of Quantitative Health Sciences (N.A.O.), Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Code L10, Cleveland, OH 44195; and Siemens Medical Solutions, Malvern, Pa (A.N.P.)
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Abstract
The barium esophagram is an integral part of the assessment and management of patients with gastroesophageal reflux disease (GERD) before, and especially after, antireflux procedures. While many of the findings on the examination can be identified with endosocopy, a gastric emptying study and an esophageal motility examination, the barium esophagram is better at demonstrating the anatomic findings after anti-reflux surgery, especially in symptomatic patients. These complementary examinations, when taken as a whole, fully evaluate a patient with suspected GERD as well as symptomatic patients after antireflux procedures.
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Affiliation(s)
- Mark E Baker
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - David M Einstein
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Guttikonda R, Herts BR, Dong F, Baker ME, Fenner KB, Pohlman B. Estimated radiation exposure and cancer risk from CT and PET/CT scans in patients with lymphoma. Eur J Radiol 2014; 83:1011-1015. [PMID: 24656401 DOI: 10.1016/j.ejrad.2014.02.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 02/15/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The purpose of this study was to estimate total effective dose and cancer risk related to treatment monitoring and surveillance computed tomography (CT) scans in a cohort of patients diagnosed with lymphoma. METHODS 76 patients with head, neck, chest, abdomen or pelvis CT and whole-body positron emission tomography (PET)/CT were identified from an institutional lymphoma database; this included 54 (71%) patients with non-Hodgkin and 22 (29%) patients with classical Hodgkin lymphoma. Average treatment and surveillance periods were 8 months (range, 3-14 mo) and 23 months (range, 1-40 mo), respectively. Radiation exposure was estimated from the dose-length product (DLP) for CT scans and milli-Curies and DLP for PET/CT scans. Cancer risk was estimated using the Biological Effects of Ionizing Radiation model. RESULTS During their treatment period, 45 patients had 161 CT exams and 39 patients had 73 PET/CT exams. Mean effective dose was 39.3 mSv (range, 7.1-100 mSv). During the surveillance period, 60 patients had 378 CT exams and 25 patients had 39 PET/CT exams. Mean effective dose was 53.2 mSv (range, 2.6-154 mSv). Seventeen of 76 (22.4%) patients had total cumulative doses greater than 100 mSv. The mean increase in estimated cancer risk was 0.40%; the greatest estimated risk to any one patient was 1.19%. CONCLUSION Mean total effective dose and mean estimated cancer risk were low in patients with lymphoma undergoing serial imaging, suggesting that theoretical risks of radiation-induced cancer need not be a major consideration in radiologic follow-up.
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Affiliation(s)
- Ravi Guttikonda
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Brian R Herts
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| | - Frank Dong
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Mark E Baker
- Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Kathleen B Fenner
- Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Brad Pohlman
- Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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Fisher K, Jacinthe PA, Vidon P, Liu X, Baker ME. Nitrous oxide emission from cropland and adjacent riparian buffers in contrasting hydrogeomorphic settings. J Environ Qual 2014; 43:338-348. [PMID: 25602568 DOI: 10.2134/jeq2013.06.0223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Riparian buffers are important nitrate (NO) sinks in agricultural watersheds, but limited information is available regarding the intensity and control of nitrous oxide (NO) emission from these buffers. This study monitored (December 2009-May 2011) NO fluxes at two agricultural riparian buffers in the White River watershed in Indiana to assess the impact of land use and hydrogeomorphologic (HGM) attributes on emission. The study sites included a riparian forest in a glacial outwash/alluvium setting (White River [WR]) and a grassed riparian buffer in tile-drained till plains (Leary Weber Ditch [LWD]). Adjacent corn ( L.) fields were monitored for land use assessment. Analysis of variance identified season, land use (riparian buffer vs. crop field), and site geomorphology as major drivers of NO fluxes. Strong relationships between N mineralization and NO fluxes were found at both sites, but relationships with other nutrient cycling indicators (C/N ratio, dissolved organic C, microbial biomass C) were detected only at LWD. Nitrous oxide emission showed strong seasonal variability; the largest NO peaks occurred in late spring/early summer as a result of flooding at the WR riparian buffer (up to 27.8 mg NO-N m d) and N fertilizer application to crop fields. Annual NO emission (kg NO-N ha) was higher in the crop fields (WR: 7.82; LWD: 6.37) than in the riparian areas. A significant difference ( < 0.02) in annual NO emission between the riparian buffers was detected (4.32 vs. 1.03 kg NO-N ha at WR and LWD, respectively), and this difference was attributed to site geomorphology and flooding (WR is flood prone; no flooding occurred at tile-drained LWD). The study results demonstrate the significance of landscape geomorphology and land-stream connection (i.e., flood potential) as drivers of NO emission in riparian buffers and therefore argue that an HGM-based approach should be especially suitable for determination of regional NO budget in riparian ecosystems.
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Lalani T, Couto CA, Rosen MP, Baker ME, Blake MA, Cash BD, Fidler JL, Greene FL, Hindman NM, Katz DS, Kaur H, Miller FH, Qayyum A, Small WC, Sudakoff GS, Yaghmai V, Yarmish GM, Yee J. ACR Appropriateness Criteria Jaundice. J Am Coll Radiol 2013; 10:402-9. [DOI: 10.1016/j.jacr.2013.02.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/26/2013] [Indexed: 01/20/2023]
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Dewhurst C, Rosen MP, Blake MA, Baker ME, Cash BD, Fidler JL, Greene FL, Hindman NM, Jones B, Katz DS, Lalani T, Miller FH, Small WC, Sudakoff GS, Tulchinsky M, Yaghmai V, Yee J. ACR Appropriateness Criteria pretreatment staging of colorectal cancer. J Am Coll Radiol 2013; 9:775-81. [PMID: 23122343 DOI: 10.1016/j.jacr.2012.07.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/31/2012] [Indexed: 02/06/2023]
Abstract
Because virtually all patients with colonic cancer will undergo some form of surgical therapy, the role of preoperative imaging is directed at determining the presence or absence of synchronous carcinomas or adenomas and local or distant metastases. In contrast, preoperative staging for rectal carcinoma has significant therapeutic implications and will direct the use of radiation therapy, surgical excision, or chemotherapy. CT of the chest, abdomen, and pelvis is recommended for the initial evaluation for the preoperative assessment of patients with colorectal carcinoma. Although the overall accuracy of CT varies directly with the stage of colorectal carcinoma, CT can accurately assess the presence of metastatic disease. MRI using endorectal coils can accurately assess the depth of bowel wall penetration of rectal carcinomas. Phased-array coils provide additional information about lymph node involvement. Adding diffusion-weighted imaging to conventional MRI yields better diagnostic accuracy than conventional MRI alone. Transrectal ultrasound can distinguish layers within the rectal wall and provides accurate assessment of the depth of tumor penetration and perirectal spread, and PET and PET/CT have been shown to alter therapy in almost one-third of patients with advanced primary rectal cancer. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Rahman MM, Haque SS, Rahman F, Ahmed K, Ahsan MR, Parvin T, Baker ME, Osmany MF, Bari N, Islam MS, Salahuddin M. Coronary angiographic profile in bangladeshi patients with metabolic syndrome and ischemic heart disease. Mymensingh Med J 2012; 21:702-708. [PMID: 23134921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The metabolic syndrome, which is characterized by a constellation of fasting hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension, and/or abdominal obesity, is a risk factor for the development of coronary artery disease (CAD) and cardiovascular events. We evaluated interrelationships between angiographic CAD and the metabolic syndrome, in 478 patients who were referred for coronary angiography to evaluate suspected myocardial ischemia in the department of cardiology of BSMMU between June 2007 and May 2008. We applied the criteria for the metabolic syndrome proposed by ATP III guideline. Study populations were divided into two groups on the basis of presence or absence of metabolic syndrome. Age was similar in both groups. Body mass index (BMI) was higher (26.22 ± 1.94 vs. 22.07 ± 1.55) in metabolic syndrome group (p ≤ 0.0001). All parameters, waist circumference (103.16 ± 10.21 vs. 91.45 ± 7.61) cm, blood pressure both systolic (141.34 ± 21.49 vs. 127.94 ± 13.01) and diastolic (86.8 5 ± 8.42 vs. 79.28 ± 7.77) mm of Hg, serum triglyceride (248.32 ± 77.88 vs. 128.35 ± 19.00)mg/dl, fasting blood glucose (125.40 ± 22.86 vs. 95.65 ± 10.63)mg/dl were significantly higher in metabolic syndrome group (p value=0.0001), whereas HDL (33.10 ± 6.55 vs. 39.30 ± 6.17)mg/dl was lower (p value = 0.0001). More subjects in metabolic syndrome were having type B (55.60% vs. 31.00%) and type C (9.50% vs. 2.70%) lesion as compared to non-metabolic syndrome group. Involvement of left main artery was more (4.80% vs. 0.90%) in metabolic syndrome group. Metabolic syndrome has primary predictive ability for CAD. A metabolic profile should form part of the risk assessment in all patients with coronary disease, not just those who are obese.
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Affiliation(s)
- M M Rahman
- Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, Grant TH, Greene FL, Jones B, Katz DS, Lalani T, Miller FH, Small WC, Spottswood S, Sudakoff GS, Tulchinsky M, Warshauer DM, Yee J, Coley BD. ACR Appropriateness Criteria® right lower quadrant pain--suspected appendicitis. J Am Coll Radiol 2012; 8:749-55. [PMID: 22051456 DOI: 10.1016/j.jacr.2011.07.010] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 07/25/2011] [Indexed: 02/09/2023]
Abstract
The diagnostic imaging of patients presenting with right lower quadrant pain and suspected appendicitis may be organized according to age and gender and to the presence or absence of "classic" signs and symptoms of acute appendicitis. Among adult patients presenting with clinical signs of acute appendicitis, the sensitivity and specificity of CT are greater than those of ultrasound, with improved performance when CT is performed with intravenous contrast. The use of rectal contrast has been associated with decreased time in the emergency department. Computed tomography has also been shown to reduce cost and negative appendectomy rates. Both CT and ultrasound are also effective in the identification of causes of right lower quadrant pain unrelated to appendicitis. Among pediatric patients, the sensitivity and specificity of graded-compression ultrasound can approach those of CT, without the use of ionizing radiation. Performing MRI after inconclusive ultrasound in pregnant patients has been associated with sensitivity and specificity of 80% to 86% and 97% to 99%, respectively. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
- Max P Rosen
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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Ribecco C, Baker ME, Šášik R, Zuo Y, Hardiman G, Carnevali O. Biological effects of marine contaminated sediments on Sparus aurata juveniles. Aquat Toxicol 2011; 104:308-316. [PMID: 21658360 DOI: 10.1016/j.aquatox.2011.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 04/28/2011] [Accepted: 05/07/2011] [Indexed: 05/30/2023]
Abstract
Chemical analysis of the compounds present in sediment, although informative, often is not indicative of the downstream biological effects that these contaminants exert on resident aquatic organisms. More direct molecular methods are needed to determine if marine life is affected by exposure to sediments. In this study, we used an aquatic multi-species microarray and q-PCR to investigate the effects on gene expression in juvenile sea bream (Sparus aurata) of two contaminated sediments defined as sediment 1 and 2, respectively, from marine areas in Northern Italy. Both sediments affected gene expression as evidenced by aquatic multi-species microarray analysis and q-PCR. Exposure of S. aurata juveniles to sediment 1 and sediment 2 altered expression of genes that are biomarkers for endocrine disruption. There were differences between the effects of sediment 1 and sediment 2 on gene expression in S. aurata juveniles indicating that the chemicals in the two sediments had different physiological targets. These results suggest that the classification of sediment solely on the basis of specific chemical profiles is inadequate, and not a true indicator of its potential to cause harmful effects. Our data also indicate that integration of physiochemical analysis and bioassays for monitoring the downstream harmful effects on aquatic organisms are required to gain a complete understanding of the effects of sediment on aquatic life.
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Affiliation(s)
- C Ribecco
- Dipartimento di Scienze del Mare, Università Politecnica delle Marche, 60131 Ancona, Italy
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